i have a "hypothetical" situation and i would like to get advice or feedback.
i have a friend who moved to another state and is a nurse. well here back in the "home" state i found out that her nursing license was suspended due to diversion ( not of narcotics, but one for a prescribed med and the other two were otc) and for falsifying work notes as well.
well she now lives in state b and has a current license in good standing. the two states are not part of a compact agreement.
should this be reported to state b or should i just let nature run its course and not say a word?
Specializes in Leadership, Psych, HomeCare, Amb. Care.
I'm not going to judge what's done in other settings, but I have never seen or heard suggested in my unit to "borrow" a med for another patient. I would go as far to say though, that if I were inclined to do this in another setting, I would draw the line at any controlled substance.
It's not unusual at all, especially in the pre-pyxis days. It wouldn't have been done with controlled meds because they were signed out from the narcotic cabinet floor stock. Nurses are resourceful problem solvers who will think creatively to meet the needs of their patients in a timely manner, even though it did break a rule. It's unlikely to happen now in acute care because of the wide use of pyxis or omnicell med dispensers, so most meds are already in stock on the unit.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I wasn't expecting to find that any one had been reprimanded- especially since we are new grads for the most part. I've actually had friends tell me to look them up, just because they are excited to be there! I'm usually too tired for other hobbies, I guess.
This thread is pretty wacky! Anyway, if it makes you feel any better -- I've always had an odd fascination with lists of names, rosters, calendars and membership directories. I'm really not nosy either!! I think I looked up my long lost classmates to see if any of them were still working! The idea of digging up dirt never crossed my mind. My mother never could figure out why I liked stuff like that. So cheer up! You're not alone! :)
Specializes in Oncology; medical specialty website.
I am sorry you looked into this and are now faced with this dilemma. However, diversion programs are taken very seriously as a way to protect the public from impaired nurses and to help impaired nurses retain thier licenses and get help with recovery be it forced through random drug screenings, strict supervision and mandatory 12 step program attendance. The diversion program in my state lasts five years. It is a rigorous program. Usually confidential unless other circumstances. If one is not compliant with the program then it becomes public and the name of the offender will go into a notification to all BONs in the nation and the license could be revoked or suspended. If you are activley aware of an impaired nurse, in my state, it is the law through the nurse practice act to notify the board. But I have always been of the mind in any conflict situation one should approach the person first and call the kettle black try to work things out and move from there. Once again these diversion programs are rigorous and cut no slack they mess with your life... I'm talking about having to attend 12 step meetings up to six times a week for years no cut backs, random drug screenings 1-6 a month that could cost up to $38 per screen with a $27 a month processing fee. The goal is the nurse gets clean, stays in recovery, and is a safe practitioner. But with all of this it is understandable that it is hard to be compliant and want to continue the diversion program...
How did this "hypothetical" nurse wind up being an impaired nurse?
This thread is pretty wacky! Anyway, if it makes you feel any better -- I've always had an odd fascination with lists of names, rosters, calendars and membership directories. I'm really not nosy either!! I think I looked up my long lost classmates to see if any of them were still working! The idea of digging up dirt never crossed my mind. My mother never could figure out why I liked stuff like that. So cheer up! You're not alone! :)
Amazing what one can find to do when they are bored. And, I looked up people on the Board list to try to find out about previous supervisors for reference purposes. That is how I found out that two of them had left the state. No wonder I couldn't locate them. Not everyone who looks up people on the Board website do so for nefarious reasons.
Well, since it's not worth your time to respond to my post, babyRN, I'll respond for you. If it were my parent in either of those situations, I would sit back and shut the hell up and let the nurse do what they have to do to take good care of my parent. This is nowhere even near the realm of a nurse diverting controlled substances for their own use. A nurse that is willing to stick their neck out to do what is right for the patients entrusted in their care is NOT a nurse I worry might hurt someone. A nurse that is unwilling to do so, on the other hand.......
I apologize if I'm coming off as abrasive, but as you correctly inferred, I'm passionate about the subject, and as I have stated in another thread, what is legal, what is moral, and what is ethical, are not necessarily the same. Please note that this is not meant as a personal attack!
Alright, I will bite. I am wide awake and it is midnight and I can't seem to get to sleep...
When I was a tech on a nursing floor, there was a sentinel event in which a nurse gave another patient's medication to someone else. She had "borrowed" it as folks have been stating here. The problem was that she didn't give out the right dose. I can't give out details due to privacy laws, but the patient in question ended up with a rapid response and later into the ICU due to this nurse. The patient in question had been on the unit for a couple of weeks and I had gotten to know the person. Everyone, including I, was shocked that this had happened. When I had stated earlier that I hadn't heard of this before, it's because my co-workers who were RNs hadn't heard of it either (although I suppose they were mostly in their 20s, early in their careers) and I had never heard of it before in my 3 years as an ICU nurse.
Such unsafe potential there...why I would never do it. If I was put in a position that would be similar to those that others have described, I would quit that facility. In the meantime, I would raise holy hell to whatever pharmacy there was that was responsible. I would call up the DON or whoever else up the chain of command. Sure I wouldn't be popular, but I always start out nicely asking. I call pharmacy all the time for my stat meds and tell the surgeons looking at their post-ops to stop poking my baby's belly as they're clamping down starting to code...I would get out of nursing before I had to put myself in that sort of situation on a daily basis. Of course, I would quit before I had to do adults anyway...but there you go.
all that being said, it seems apparent that this practice is the norm in many places (who knew? nobody taught this in nursing school afterall, it can't be true ). My parents are now 53 and 52. I have been after them to get decent long-term care insurance with good nursing ratios (if such a thing exists) and now I suppose with decent access to pharmacies. Of course, my dad was an adult ICU nurse, so he would probably be keeping an eagle eye on everything anyway, assuming he's not demented. If it was my mom, I'm sure dad would look after everything with her as well, but if it was both I guess I would have a new part-time job. We all want what's best for our patients--I guess I just have a different idea than others.
My earlier posts were stated in passion and "righteous" anger as some folks have labeled. Stages of grief much? Shock, anger, bargaining, acceptance? My interim post about not wanting to discuss it further was because I knew if I went further on I would be much harsher and meaner than I would intend to be... I suppose in a world where we have infants with narcotic withdrawal and parents who kill their infants by letting their oxygen tank run out but get away with it, I could hardly expect a perfect world otherwise on the other side of the life spectrum.
I am sorry that you guys don't have the support that you need to not borrow medications from other patients. That majorly sucks. I wish you guys well.
I know I'm not Stargazer (at least I've got that down !!) but I've been along on this thread, so will throw in my 2cents :) If the nurse reads the labels, it helps
LTCs are like this the vast majority of the time (I've worked in several, in 2 states)- any who say it doesn't happen is lying. Don't believe them. And decent pharmacy access to LTC is an emergency number, and "stat" service that is at least an hour away...need it sooner? I had to get an order to transfer to the ER. That's just how it is in the real world of adult/LTC nursing. NICU gives you a LOT of skills. But it's also a bit shielded from what happens IRL, especially LTC. :) (and your folks are really young- don't sign the paperwork to admit them yet - LOL....getting the LTC insurance is a really good idea. They are extremely expensive, and a quick way to chew through assets).
Most LTCs try to do a good job, and the majority of nurses there would sever a limb for their residents. They do what they can to provide safe, compassionate care. Nobody stays in LTC just for a 'job'...they just don't last. Is it ideal- no...not even close. But it's the best they have. And it's better than it used to be. Staffing now is a LOT better than when I graduated in 1985.
The pharmacy could be the local Walgreens with a contract with the LTC. There are VERY few LTC companies with their own pharmacy companies with them (though that does help). And the vast majority of the time, that's enough. These are generally folks who have their meds fairly well situated. If they didn't they'd be in LTAC or a rehab hospital. Or inpatient.
Nobody likes borrowing. I've never seen a nurse who does it indiscriminately, and often co-workers would talk about it between themselves (especially if one had a patient who needed a med the other nurse had for one of her patients). But the alternative is watching the patient go without- and sometimes that is much riskier than taking a med that is labelled, and giving it to the patient. These are not unit dose meds. They are large blister cards that hold 30-90 'bubbles' with the pills inside. It's not like grabbing from a 24-hour drawer, where you have a lot of different meds all mixed in the same drawer. The card only carries that med.
I can understand being spooked by this from what you have seen- but that nurse should have looked at the dose. It was a nurse error. Could it happen again- yep. That's why it's important for any nurse in any situation to read the labels and MARs as many times as needed to be sure they're giving the right med.
I've gotten the wrong med more than once from a pharmacy (different ones /different cities) as just a regular customer. My dad had asthma meds given to him for a different person (same name, different address that the tech nodded yes to, as he looked at the label that was wrong)..my dad was post-op and had PAIN meds ordered- not even close to theophylline. I happened to pick the rx up, and read the label before leaving the parking lot (drive thru pharmacy) Mistakes are because of people or procedures. And no place is immune.
What is going on here, is doing the best possible thing given the situation and available options. A trip to the ER for a 'routine' med that isn't there isn't covered by Medicare. And it plugs up the ED needlessly (and I'd be royally peeved to have to ship someone out for a pill that is sitting in patient B's card).
Reporting everything is up to you. :) But you're going to get really tired of it. Pick your battles, and if you aren't directly involved, or there wasn't patient harm, think twice before getting involved. It's going to be a very long career (or very short if you limit your options). :)
^^ going to bed now whether I feel like it or not! (think it was the caffeine I had this afternoon) but I will say that it really hasn't been an issue for me as far as reporting goes because literally, as I said, I have never heard of anyone on my unit doing it. And I am not big into reporting folks. There are some nurses on my unit (I'm sure we all have them) that will report every little thing to the point where our supervisors ask, "uh...why?" and don't even exercise good judgment, i.e. incident that patient has not had antibiotic given in the chart. However, the nurse didn't bother to call the other nurse at home to see if she had given it, but forgotten to chart it! d'oh.
I don't use names either and write incidents when I write them (infrequent) when it's a real patient safety concern or systemic error that needs to be looked at (i.e. I once had to throw away 150cc of breast milk one time because somebody had thawed too much out at the same time and it expired, never mind that the infant in question was a short-gut kid due to necrotizing enterocolitis and needed all of mama's juice the baby could get (and 150cc goes a LONG way on a kid only on 1cc/hr) and this was the end of the mama's supply).
Would I write up someone for using another kid's drug in my unit? Probably. Because if they needed a narcotic or pressors or sedation, they can grab it out of the pyxis along with stat abx. Otherwise they can harass pharmacy for the drug. The system is in place here that you shouldn't need to do that. I suppose it's harder to understand other practices since we are in our own world in an ICU where everything is demanded now and gotten pretty much now. God bless you LTC nurses...I could not do your job.
What the heck? I have NEVER given another patient someone else's drug. Are you telling me that you give people's medications to other patients? You have GOT to be kidding me. I am not a wet-behind-the-ears nurse, I have 3+ years experience and work in a critical unit pushing meds all the time and I have NEVER done this and to be frank, I have never heard of another nurse doing this.
I guess I *will* have to babysit all the nurses that might take care of my parents in the future if that's the norm among nurses. For pete's sake...
I have...not on purpose...I had a pt having an acute MI, he was on heparin, and needed to start on a glycoprotein IIb/IIIa. His troponins were rising fast, and we were waiting on the cath lab to come in. After waiting over an hour, after numerous calls to pharmacy the bottle finally came up...I scanned, spiked it, ran the bolus correctly, hung it at the correct rate. I even had a second nurse verify with me. Of course we were hanging nitro, pushing morphine, then threw everything on the bed, and RAN with the pt to cath lab.
Only the integrelin was labeled for a patient in a different room. Right med, right patient, right time, right dose, right route, WRONG label.
The integrelin did arrive from pharmacy, after the pt was in the cath lab.
Sorry late reply...my internet is really slow tonight, due to wildfires in the region...but yes I did give borrow meds...
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
alright, i will bite. i am wide awake and it is midnight and i can't seem to get to sleep...
when i was a tech on a nursing floor, there was a sentinel event in which a nurse gave another patient's medication to someone else. she had "borrowed" it as folks have been stating here. the problem was that she didn't give out the right dose. i can't give out details due to privacy laws, but the patient in question ended up with a rapid response and later into the icu due to this nurse. the patient in question had been on the unit for a couple of weeks and i had gotten to know the person.
the problem wasn't that she borrowed the medications -- it's that she didn't give the right dose. that can happen even using the patient's own meds. ("um, there's six pills in here so i give all six, right?" well no, that's six doses.)
). My parents are now 53 and 52. I have been after them to get decent long-term care insurance with good nursing ratios (if such a thing exists) and now I suppose with decent access to pharmacies. Of course, my dad was an adult ICU nurse, so he would probably be keeping an eagle eye on everything anyway, assuming he's not demented. If it was my mom, I'm sure dad would look after everything with her as well, but if it was both I guess I would have a new part-time job. We all want what's best for our patients--I guess I just have a different idea than others. 
MrChicagoRN, RN
2,610 Posts
It's not unusual at all, especially in the pre-pyxis days. It wouldn't have been done with controlled meds because they were signed out from the narcotic cabinet floor stock. Nurses are resourceful problem solvers who will think creatively to meet the needs of their patients in a timely manner, even though it did break a rule. It's unlikely to happen now in acute care because of the wide use of pyxis or omnicell med dispensers, so most meds are already in stock on the unit.